Esophageal Varices: The Daily PANCE Blueprint
A 52-year-old man with alcohol-related cirrhosis presents with hematemesis. On exam, he has scleral icterus and ascites. Hemoglobin is 7 g/dL. Which of the following is the most appropriate next step in management?
A. Octreotide infusion
B. Ceftriaxone and lactulose
C. Vasopressin infusion
D. Sengstaken-Blakemore tube
E. Urgent EGD
Answer and topic summary
The answer is E) Urgent EGD
This patient with cirrhosis presenting with hematemesis is concerning for bleeding esophageal varices. Guidelines recommend urgent EGD for diagnosis and band ligation as definitive management. Octreotide and vasopressin can be used to temporize bleeding before endoscopy but EGD should not be delayed. Ceftriaxone and lactulose may be indicated for hepatic encephalopathy but do not treat variceal bleeding. Sengstaken-Blakemore tube tamponade is second-line after failing band ligation.
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Smarty PANCE Content Blueprint Review:
Covered under ⇒ PANCE Blueprint GI and Nutrition ⇒
